Sec. 202. Providing for additional requirements with respect to the navigator program
1,076 words·~5 min read·
/bill/116/hr/987/eh/section-202A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1311(i) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(i) ) is amended— in paragraph (2), by adding at the end the following new subparagraph: In the case of an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), in awarding grants under paragraph (1), the Exchange shall— select entities to receive such grants based on an entity’s demonstrated capacity to carry out each of the duties specified in paragraph (3); not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section 2510.3–5(b) of title 29, Code of Federal Regulations (or any successor regulation), or short-term limited duration insurance (as defined by the Secretary for purposes of section 2791(b)(5) of the Public Health Service Act); and ensure that, each year, the Exchange awards such a grant to— at least one entity described in this paragraph that is a community and consumer-focused nonprofit group; and at least one entity described in subparagraph (B), which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause (I).
In awarding such grants, an Exchange may consider an entity’s record with respect to waste, fraud, and abuse for purposes of maintaining the integrity of such Exchange. . in paragraph (3)— by amending subparagraph
(C)to read as follows: facilitate enrollment, including with respect to individuals with limited English proficiency and individuals with chronic illnesses, in qualified health plans, State medicaid plans under title XIX of the Social Security Act, and State child health plans under title XXI of such Act; ; in subparagraph (D), by striking and at the end; in subparagraph (E), by striking the period at the end and inserting a semicolon; by inserting after subparagraph
(E)the following: conduct public education activities in plain language to raise awareness of the requirements of and the protections provided under— the essential health benefits package (as defined in section 1302(a)); and section 2726 of the Public Health Service Act (relating to parity in mental health and substance use disorder benefits); and ; by inserting after subparagraph
(F)(as added by subparagraph (D)) the following new subparagraph: provide referrals to community-based organizations that address social needs related to health outcomes. ; and by adding at the end the following flush left sentence: The duties specified in the preceding sentences may be carried out by such a navigator at any time during a year. ; in paragraph (4)(A)— in the matter preceding clause (i), by striking not ; in clause (i)— by inserting not before be ; and by striking ; or and inserting a semicolon; in clause (ii)— by inserting not before receive ; and by striking the period and inserting a semicolon; and by adding at the end the following new clauses: maintain physical presence in the State of the Exchange so as to allow in-person assistance to consumers; receive training on how to assist individuals with enrolling for medical assistance under State plans under the Medicaid program under title XIX of the Social Security Act or for child health assistance under State child health plans under title XXI of such Act; and receive opioid specific education and training that ensures the navigator can best educate individuals on qualified health plans offered through an Exchange, specifically coverage under such plans for opioid health care treatment. ; and in paragraph (6)— by striking and inserting Funding.— Grants under Funding.— Subject to subparagraph (C), grants under ; and by adding at the end the following new subparagraphs: For purposes of carrying out this subsection, with respect to an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), the Secretary shall obligate $100 million out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2020 and each subsequent fiscal year. Such amount for a fiscal year shall remain available until expended. For the purposes of carrying out this subsection, with respect to an Exchange operated by a State pursuant to this section, there is authorized to be appropriated $25 million for fiscal year 2020 and each subsequent fiscal year. Each State receiving a grant pursuant to this subparagraph shall receive a grant in an amount that is not less than $1 million. . Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall study the effects of funding cuts made for plan year 2019 with respect to the navigator program (as described in section 1311(i) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(i) )) and other education and outreach activities carried out with respect to Exchanges established by the Secretary of Health and Human Services pursuant to section 1321(c) of such Act. Such study shall describe the following: How such funding cuts negatively impacted the ability of entities under such program to conduct outreach activities and fulfill duties required under such section 1311(i). The overall effect on— the number of individuals enrolled in health insurance coverage offered in the individual market for plan year 2019; and the costs of health insurance coverage offered in the individual market. For plan year 2020 and each subsequent plan year, not later than the date that is 3 months after the end of such plan year, the Secretary of Health and Human Services shall submit to the appropriate committees of Congress and make available to the public an annual report on the expenditures by the Department of Health and Human Services of user fees collected pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations). Each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated Exchange operated pursuant to section 1321(c) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18041(c) ) on outreach and enrollment activities, navigators, maintenance of Healthcare.gov, and operation of call centers. The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2020.
Connectionstraces to 2
Citation graph
cites case law
Sec. 202
Providing for additional requirements with respect to the navigator program
Cites 2Cited by 0 across 0 sources